Lecture 13, Sports Injuries Of The Trunk Flashcards
Rupture of pec Minor
Who is it seen in?
Hx and sx
Physical
Treatment
Weightlifters! Wrestlers! Javelin throwers!
History: Pt reports a pop or tearing sensation along the anterior chest wall of the affected side, pain at insertion of pectoral muscle, bruising at anterior arm
Physical: symptoms + loss of muscle definition, decreased muscle strength, swelling and ecchymosis around the anterior shoulder and chest wall, tear site is tender, loss of the anterior axillary fold
Treatment: depends!
-for partial tears: early strength training and physical therapy
-for complete tears: require surgical repair which typically requires 6 months or longer to regain full mobility and function
Return to play instructions — for partial, once strength is normal and no more pain with normal ROM is achieved
For complete, 3-5 months following surgery and PT
Sternoclavicular Dislocation
Hx
Physical
Imaging
Treatment
Return to play
Hx: a direct, high-velocity blow to the medial clavicle
-anterior dislocation: direct blow to point of shoulder
-posterior dislocation: blow to clavicle or chest with shoulder in extension
-repetitive overhead movement
Physical: prominence at the clavicle in anterior or depression at the clavicle in posterior (**posterior is life threatening d/t proximity to lungs, heart, aorta, subclavian vessels and trachea)
Imaging:
plain radiographs with the serendipity view
Contrast-enhanced CT to evaluate for vascular injury
Treatment:
-anterior: sling or closed reduction
-posterior: urgent closed reduction unless compromising vital structures
Return to play: immobilization and then physical therapy to get gentle ROM with strengthening
Rib fracture
History:
Etiology:
Physical:
Imaging:
Treatment:
Hx: pain to affected rib (worse with deep breaths, pt may be SOB)/ can be d/t blunt trauma of course, but also severe coughing, sports and child abuse
-pain on inspiration
-localized pain to 1 or 2 ribs
Physical: -point tenderness on a specific rib or focal tenderness caused by compression of the rib cage distant from the site of pain
Imaging:
Chest xray for blunt trauma
Bone scan or MRI for stress fracture
CT if lung/hepatic/splenic injury is suspected
Treatment:
Rest, OMT, rarely surgery
Return to play depends on tolerability of activity ~ 3 weeks
Slipping rib syndrome - Pain syndromes involving the lower ribs
Hx:
Etiology:
Physical:
Treatment:
What is the hooking maneuver?
What test can confirm diagnosis?
Hx: atraumatic/repetitive/overuse injury, pain to affected rib, popping/clicking sound followed by dull ache
Etiology: unknown; usually ribs 8-10 MC affected, affects distance swimmers
Physical: pain, positive hooking maneuver for diagnosis
Hooking maneuver: examiner curled fingers are hooked under the ribs at the costal margin and the ribs are gently pulled forward, reproducing the patients symptoms
Treatment: rest, NSAIDS and avoidance of inciting activities
-promo therapy and intercostal nerve block to confirm diagnosis
-if all else fails, surgery
Rectus Abdominis Strain/Rupture
MC site of injury?
Who do you see it in?
Hx
Physical
Dx
Tx
MC site of injury is near insertion on the pelvisbut can occur anywhere along rectus
Seen in weight lifters, throwers, rowers
Hx: sudden stabbing pain in abdomen w forceful use (or dull ache if chronic), maybe related to acute injury or repetitive/overuse problem,
Physical: can be difficult to distinguish from internal abdominal organ damage; has local pain on palpation and pain is elicited if pt lies flat and lifts legs against resistance
Dx: mostly by PE, but MRI or CT if want to rule out internal organ issue
Treatment: rest, strengthening, OMT for counterstrain TPs. Surgery is needed if hernia develops
Return to play depends on extent; overuse may return in 1-2 weeks
Osteitis Pubis
What is it
History
Physical
Treatment
Inflammatory condition of the pubic symphysis and surrounding structures
-overuse
-athletes and pregnancy, pelvic trauma or surgery
Hx: insidious onset of pelvic pain in the absence of systemic symptoms, i have pain in my groin, radiating, pain in the morning after exercise
Physical: tenderness over the pubic symphysis or pain with resisted adductor testing
Treatment: rest, ice, NSAIDS and pT, if fails the give corticosteroid injections
Sports Hernia
Hx:
Etiology:
Physical:
Imaging:
Treatment:
History: poorly localized groin pain worse with activity, radiating, pain with coughing. unilateral
Groin pain exacerbated by any sudden increase in intra-abdominal pressure, crunches hurt, discofort with adDuction
Etiology: Disruption of the external oblique muscle with concomitant injury to the ilioinguinal nerve OR congenital weakness of posterior wall of the inguinal canal OR just typically in men who are in high intensity sports
Physical: no recognizable hernia, not easy to detect. May have tenderness. Worse over pubic tubercle on the affected side
imaging: Dynamic ultrasound and MRI. usually a diagnosis of exclusion!
Tx: rest and physical therapy
Surgery if sx do not resolve
Snapping Hip syndrome
Hx:
Physical:
Treatment:
slippage of the IT band or gluteus Maximus tendon over the greater trochanter (external) or slippage of the iliopsoas tendon over the lesser trochanter
History: Audible snap or click that occurs at the hip, may or may not hurt . Seen in dancers and gymnasts
Physical: Anterior hip pain or groin pain (internal) - frog leg position to elicit this
Lateral hip pain (external)
Treatment: rest. Steroids, NSAIDS, PT and activity
Hip pointer
hx:
Physical:
imaging:
Treatment:
contusion of the superior iliac crest sustained from a fall or blow during a sport. MC football.
History:
Physical: pain at contusion site — ecchymosis, swelling, tenderness, limping, **difficult w resisted hip adDuction
Imaging: xray to r/o fracture or other pathologies
Treatment: PRICES (protection, rest, ice, compression, elevation
Hip Labral Tears
Pt presents with hip pain that. Is exacerbated by physical exam maneuvers ?
What would be the predisposing condition?
fibrocartilaginous structure that resides on the rim of the acetabulum
Hx: poorly localized anterior hip/groin pain, some pts have clicking or catching
Etiology: isolated traumatic event or repetitive trauma higher risk if femoral acetabular impingement is present,
Physical: abnormal gait with shortened stance phase, reproducible groin pain with forced FADIR (impingement test), pain with FABER, limitations of terminal motion of the hip
Imaging: if femoral acetabular impingement = do xray/MRI, impingement test, or injection of local anesthetic to relieve pain, MR arthrogram is gold standard
Treatment: relative rest, ice compression and NSAIDS
Corticosteroid injection for severe pain and needle drainage for hematomas
Femoral Acetabular Impingement Syndrome
Pathological contact between the femoral head-neck junction and acetabular rim during a functional range of hip movement
-movement or position-related groin pain
-flexion, aBduction and internal rotation of the hip
(May have associated labral tear)
Imaging: AP pelvis and lateral view of the symptomatic hip
Treatment: corticosteroid injections, NSAIDS and exercise-based rehab
Hip snapping with pain in the groin , which tendon?
Snapping Hip Syndrome
IT band
OR
gluteus Maximus TENDON
